Lumbar spinal stenosis is one of many potential causes for low back pain. It impacts millions of people: 20% of people over the age of 60 will have some type of spinal stenosis and over 2.5 million people are currently in treatment for it.
Lumbar spinal stenosis is the narrowing of the open space in your spine. The narrowing can come from a ligament that gets thicker, from extra bone growth, or from a disc in your spine bulging. All of these conditions can combine to make the opening in your spinal narrower and put pressure on the nerves that go through that opening, causing symptoms.
Lumbar spinal stenosis limits the quality of life of patients. It’s hard for patients to stand or walk for longer than brief periods. They may get pain in their back and hips or tingling in their legs. Leaning forward, such as onto a shopping cart, can provide relief from symptoms.
The MILD procedure
I perform a relatively new procedure called the Minimally Invasive Lumbar Decompression (MILD) procedure, which has been spreading across the country over the past 2-3 years. A MILD addresses the root cause of spinal stenosis: the narrowing of the spine. It’s designed to treat the leg pain and give you the ability to stand longer.
After numbing your skin, a small incision is made in your back. A pencil-sized tool goes into the incision to clean out that ligament and reduce the narrowing. It’s a very short outpatient procedure with a very high safety profile. It’s done with a small amount of numbing medicine and some light sedation.
The MILD procedure is an option for many patients, from mild to severe stenosis. It’s appropriate for people who cannot have larger back surgeries due to other conditions, such as their BMI or medications they are taking. It can also be done on some patients who have already had back surgery, depending on the specifics of the original surgery. MILD is approved for all levels of the lumbar spine, but not the upper back or neck.
The MILD procedure has the equivalent safety profile as an epidural steroid injection. With spinal stenosis, we generally try at least one epidural steroid injection prior to the introduction of the MILD procedure. But for patients who have spinal stenosis, the injection may not help for very long, and patients were previously having to get multiple injections a year. With the MILD procedure an option, if the injection doesn’t provide lasting relief, the procedure can be tried next.
Two years after the MILD procedure, studies did not find any type of spinal instability in patients, and since there’s no hardware and very little disruption of the spine, there’s no spinal fractures or hardware complications at two years. Cleveland Clinic’s study at one year showed that patients who had the MILD procedure had a 600% improvement in 12 months in their ability to stand longer and were able to walk 1500% farther than they had been able to before the procedure.
Benefits
- Very short outpatient procedure
- Generally only need a single incision, although may need up to four
- Can clean out one-two levels on both sides; occasionally can do 3 levels
- Very low risk profile
- Not masking pain, but treating pain by removing the thickened ligament that is causing the pressure
- If the MILD doesn’t work, it doesn’t restrict you from other treatments such as a spinal cord stimulator or a larger back surgery
- Most people are up and about within 24 to 48 hours after the procedure
Questions to think about before your appointment
- Where do you experience discomfort?
- Does sitting or bending forward relieve your discomfort?
- How long can you stand before you need to rest?
- How far can you walk before you seek relief?
- Which daily activities are affected due to your discomfort?
Additional information
Before the MILD procedure, we need to see an MRI that has been taken within the past year. We’ll go through your MRI with you and discuss what we see and potential treatment options. If you have narrowing of the spine, we’ll potentially discuss the MILD procedure as one of those treatment options.
After the MILD procedure, patients are usually up within 24 to 48 hours and walking around within 2 to 3 days. I have my patients start physical therapy one week after MILD. The physical therapy helps patients with reconditioning and balance, since they have not been up and walking around for a long time. There are postoperative appointments at 2 weeks and 4-6 weeks after the procedure.
FAQs
Does the MILD procedure have the same benefits as spinal fusion?
Spinal fusion can be used as a treatment for several different conditions, so it’s not an exact comparison. If the spinal fusion is a treatment for spinal stenosis, the MILD procedure can have equivalent outcomes. The data on the MILD procedure is about 2-3 years old and has shown some sustained relief. The MILD procedure is less aggressive than a spinal fusion, as it can be done as an outpatient procedure where the patient goes home the same day. A large lumbar fusion could treat multiple causes of spinal stenosis but will come with a higher risk profile.
Can a patient have the MILD procedure after they have had a lumbar fusion?
Yes, a patient can have the MILD procedure above the level of the fusion, and in certain cases below the level of the fusion. The details are on a case-by-case basis.
Once you’ve had a spinal fusion, the deterioration of the spine above and below the fusion can accelerate so we would need to do careful imaging ahead of time to make sure we could get the tools in to do the MILD procedure.
Is MILD an office procedure or is it done in a hospital?
MILD is done in an outpatient surgery center or a hospital, not in an office.
Would wearing braces on your back help to delay the need for the MILD procedure?
We prefer patients not to constantly wear a brace, as it can compromise your core muscles and you may need physical therapy to wean off the brace. I only recommend braces for patients during activities you know will cause back pain, such as pushing a refrigerator or helping a friend move. Wearing a brace constantly has shown no benefit for patients with spinal stenosis.
When does MILD not work and why does it not work?
MILD may not work if the majority of the narrowing is due to a disc herniation or arthritic joints. The tools I use for MILD can’t change a disc bulge or herniation, and can’t change an arthritic joint. The MRI is crucial so we can look at the cause of your narrowing and pick the appropriate treatment for you.